Tradesman's Liabilty Insurance - Quotation Request

Proposer's name

E-mail address

Company or trading name

Business address

Postcode

Telephone No

Fax No (optional)

Are you an existing Rowett Insurance client?

Yes No

Full names of Principals, Partners & Directors

1.  
2.  
3.  
4.  
5.  

Compulsory cover

Public Liability

please select indemnity limit

£1M £2M £3M

Optional cover (please select as required)

Employer's Liability

Yes No

Tools

Yes No

About the business

Please provide full description of work

If your trade or business is a builder state whether

a) properties worked on are only private dwellings, flats, schools, shops & offices

Yes No

b) properties worked on exceed 15 metres in height

Yes No

c) it involves structural work

Yes No

d) it involves demolition other than as a contract to rebuild by you

Yes No

If your trade or business is Electrician state whether your work involves work on 3 phase installations, controls or machinery

Yes No

How many people are involved in manual work?

a) Principals & Directors

b) Employees including labour only sub-contractors, hired people and people working under Government Sponsored Schemes (maximum number required at any one time is required)

Will you handle or use any of the following in connection with your business?

a) silica asbestos or substances containing asbestos

Yes No

b) acids, gases, explosives, radioactive or similar dangerous liquids or substances

Yes No

Does any of your work involve the following?

a) power stations, nuclear installations or establishments

Yes No

b) refineries, bulk storage or production premises in oil, gas or chemical industries or offshore structures

Yes No

c) aircraft, hovercraft, aerospace systems, watercraft or railways (underground or underwater)

Yes No

d) work in or on computer suites or on computers

Yes No

Has any insurer cancelled, declined to renew or declined to provide cover in respect of any partner or director?

Yes No

Have you or any partner or director ever been convicted of or prosecuted for any criminal offence involving dishonesty, arson, theft or wilfull damage or for a breach of any statute relating to health and safety at work or is any prosecution outstanding?

Yes No

How many years experience do you have in the trade?

Have you or any of the Partners or Directors made any insurance claim, been claimed against or suffered any event which may lead to a claim for any of the covers proposed (whether insured against or not) in the last 5 years

Yes No

if yes, please give details below (one per line please )

Details of claim

£
Settled

£ Outstanding

Year

Insurance required from

Renewal Date of present insurance (if applicable)

Preferred Payment Method

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